If you were given that choice, for real, could you change?
Alan Deutschman asks that question in his book Change or Die (Regan,
2007). Unbelievable as it seems, he says the odds are nine-to-one that you would
not change. He gives facts and figures to back up his assertion—and then lays
out a three-part formula for beating the odds. He calls it the3Rs:
“Relate, Repeat, and Reframe.” In plain terms, “new hope, new skills, and new
thinking.”

Deutschman gives many excellent examples, but the two that
interest me most involve heart disease and his own struggle against obesity. His
distressing odds ring true in both cases. It is well known that over 90
percent of people who lose weight gain it all back, and usually more. Weight
loss, of course, is rarely a near-term life-or-death situation. Heart disease,
however, is another story.

Deutschman says patients will not change their lifestyle
after coronary bypass or angioplasty surgery—even if their life depends on it.
Citing Edward Miller, MD, dean of the medical school and chief executive officer
of the hospital at Johns Hopkins University, as his authority, he explains that
such surgeries “are no more than temporary fixes.” They relieve the patient’s
pain, but only for a while. “The bypass grafts often clog up within a few years;
the angioplasties, in only a few months,” he tells us.

Doctors tell their patients that they must “switch to a
healthier lifestyle” if they want to keep the pain from coming back, avoid
repeat surgery, and stop the disease before it kills them. Nevertheless, few
change.

“If you look at people after coronary bypass grafting two
years later, ninety percent of them have not changed their lifestyle,” says Dr.
Miller. “Even though they know they have a very bad disease and they know they
should change their lifestyle, for whatever reason they can’t.”

Amazingly, people won’t even keep taking a pill which has a good
chance of saving their life. A study of 37,000 patients who were prescribed
statins found that nearly everyone took the pills for a month or two, Deutschman
relates, but by the third month about half had stopped, and one year later only
“one fifth to one third” were still taking the statins, “which they were
supposed to keep taking for the rest of their lives.”

“Facts and fear,” no matter how soundly based, don’t work.
”The real key is to give people hope, not facts,” says Deutschman. There’s more
to it, of course, but that’s the crucial first step. Dr. Dean Ornish’s program
for heart disease sufferers is an inspiring example. You’ll have to read the
book to get all the details, but here’s a thumbnail sketch.

The Ornish Team Approach

Unfortunately, doctors know from their own clinical
experience and research literature that the history on patient compliance is not
good--dismal really. “After performing the miracle surgeries and prescribing the
miracle drugs,” Deutschman writes, “the doctors remind you [that] you’ve got to
start living in a healthier way,” but “they really don’t believe you can
change.” (Emphasis mine) “Their lack of conviction, betrayed by the look in
their eyes or the tone of their voice or their body language, takes away from
the impact of their words.”

What distinguishes Dean Ornish, MD, a professor of medicine
at the University of California at San Francisco, is that he believes in
lifestyle change--and has the experience and research to back it up.

After a series of smaller, and successful, trials starting
in the late 1970s, Ornish and his colleagues in 1993 identified 333 patients who
suffered from “severely clogged arteries” and had qualified for bypass or
angioplasty surgery. In many cases, these patients were suffering from crippling
disease and needed immediate relief. The Ornish group persuaded 194 of the 333
to forego surgery (which would practically guaranty immediate relief) and try
lifestyle change instead.

“Staffers helped them quit smoking and switch to an extreme
vegetarian diet that derived fewer than 10 percent of its calories from fat,”
Deutschman relates. “The patients got together for group conversation twice a
week, and they also took classes in meditation, relaxation, yoga, and aerobic
exercise, which became part of their daily routine.”

After one year, when the program ended and they were on their own, one
would expect them to lapse into an unhealthy lifestyle. Actually, conventional
wisdom would expect most of them to drop out of the rigorous program before the
end of the first year. “But three years from the start,” Deutschman writes, “77
percent of the patients had stuck with these lifestyle changes—and safely
avoided the need for heart surgery. They had halted—or, in many cases,
reversed—the progress of their disease.”

What allowed the Ornish team to reverse the odds, and
inspire almost 80 percent of the patients to stick with the program and
transform themselves?

Briefly, Dr. Ornish’s team took the time to sell the patients on the idea
that they could change; they gave them hope and made them believe in themselves.
Next, they helped them learn and practice new habits and skills. Finally, they
encouraged the patients to think about their disease in a new way, to help
themselves.

Deutschman contrasts the Ornish approach with the
conventional strategy which relies almost entirely on the doctor, who tells the
patient the facts of their case and that he or she must change. As noted above,
the doctor doesn’t really believe the patient can change. Both the doctor and
the patient believe that surgery and drugs are the only viable option.

The Ornish approach uses a team of
professionals, including a cardiologist, psychologist, personal trainer, chef,
and a yoga or meditation instructor, who all “fervently believe patients can
change.”

The approach also offers another powerful motivator:
dramatic results. In all of the Ornish trials (Deutschman describes four), the
frequency of chest pains fell by 90 percent or more within the first month. “The
rapid improvement helps to sell the patients on the program and inspire
them to stick with it even though it’s a very demanding change,” Deutschman
emphasizes.

Motivated by dramatic early success and a full year of
practice (exercise, yoga or meditation, support group, and meal preparation)
under the watchful eyes of the team of professionals, the patients are instilled
with the understanding and belief necessary to continue on their own.

You are probably thinking that the team approach sounds
expensive. You’d be right, $7,000 per patient, but that’s far less than $46,000
for bypass surgery and $31,000 for angioplasty. Apparently, the cost efficiency
is finally getting through to the powers that be: In 2005, Deutschman
reports, Medicare decided to cover the costs of the Ornish program.

Now, let’s move on the author’s weight problem. We’ll focus
mainly on the first part of the formula, relate or new hope, because that’s the
key to change.

Author Overcomes Obesity

Alan Deutschman says obesity “snuck up on me.” At 25, he
was about 160 at almost five-nine, and still slender. Two years later, however,
he found himself weighing 200, and it got worse from there. At 30, he had to
fudge on his weight to get health insurance. At 31, he weighed 222 and was so
fat that his editors at Gentlemen’s Quarterly recruited the chief
personal trainer at an upscale gym to help him lose weight. The personal trainer
was a former Mr. America, which turned out to be problem. “[He] was entirely
amiable, but I could never see him as a role model,” Deutschman relates. “No
matter what I did, or how hard I tried, I knew that I would never look anything
like him or be like him.”

What’s more, he says, “the place was filled with beautiful
people—I was much too self-conscious and felt out of place.”

To make a long story short, he lost about six pounds at the
start, but gained it all back, and soon gained six more—“which brought up my
weight to its all-time peak of 228.” At 33, he moved to another city, where he
joined a fitness center within walking distance of his apartment; but he
couldn’t make himself go to the gym regularly and had no better luck getting his weight
under control. “I was nearly resigned to the idea that I was an obese person and
I simply wasn’t going to change. It was becoming my identity.”

Happily, that was his low point. The gym that he rarely
went to closed down unexpectedly and, prodded by his girl friend, he “joined a
small, friendly gym” nearby. The membership entitled him to two free sessions
with one of the gym’s personal trainers. That’s when things really started to
look up. The new trainer, an energetic young woman with “an infectious
enthusiasm for exercise,” turned out to be the key to solving his weight
problem.

“I bonded with Claudia partly because of our similar
backgrounds and interests and partly because I was intrigued by our
differences,” Deutschman writes. “Unlike ‘Mr. America,’ Claudia wasn’t from
another planet—she was from my planet, which made a big difference. She was like
me in so many ways that it made me believe that I could be like her in the other
ways—that maybe I could become fit and vibrantly healthy.”

He could relate to her; she made him believe.

Within months, his weight dropped to 188, and has stayed
there for five years and counting. “I went from dreading the idea of running a
one-quarter mile lap around the track to looking forward to going out and
running three miles on my own.”

More important than the actual process of losing weight and
becoming fit (which, of course, is important), Deutschman explains, is “having a
relationship with people who believe in you and whom you believe in as well….One
of Claudia’s great gifts is that she truly believes and expects that her clients
will learn to love exercise, even if they haven’t worked out much in their
past.” Her belief helps her clients to believe in themselves.

That’s the take-home message. In my own case, I believe
that’s why many people relate to me now who didn’t relate to me when I first
appeared in Muscle & Fitness. I was younger and lean, but not young
enough to appeal to guys in their 20s. But now that I’m older--and still
lean--and they’re in their 40s, it’s another story entirely. They identify with
me now—and relate to my message. They can see themselves benefiting from my
example and perhaps following in my footsteps.

“When you find the right relationship,” Alan Deutschman
proclaims, “anything is possible.”